National Paediatric

Undergraduate

Curriculum

National Paediatric Undergraduate Curriculum

1 Introduction

In essence this curriculum is designed to pool all our expertise to develop an agreed national

paediatric curriculum. Individual paediatric courses vary in content and duration across the

country but the aim is to ensure that those who complete the paediatric course will

understand what is different about paediatrics and dealing with children and young people

and in essence be a safe doctor in dealing with children. I have attempted to collate the best

of current curricula (including national curricula from Canada and the UK) and to try to take

out the very best of each and weave into an agreed national curriculum.

The curriculum identifies knowledge, skills and attitudes in child health that we think should

be covered at some stage during the undergraduate medical course. The curriculum is

deliberately brief, defining only the core components of child health for medical

undergraduates. The specific details of what is covered, the depth of coverage and how

teaching is delivered is up to individual medical schools.

All doctors will come across children and families in their work and it is essential that newly qualified doctors can competently interact with, assess and care for children and young people. Our hope is that this curriculum represents the beginning of a process and we hope it will

act as a springboard for sharing teaching aids, assessment methods and examination

questions through national discussion and collaboration, generating ideas which will

improve child health teaching for medical undergraduates in Ireland. Ultimately this process

should enable the development of an agreed e-textbook or app for use by students (both

undergraduate and postgraduate) across Ireland and the world.

2 Essential Curriculum Outcomes The graduating student will:

Be able to take a paediatric history and perform a clinical examination in newborns, infants, toddlers, older children and adolescents (including children with complex medical needs) to formulate a differential diagnosis and identify relevant investigations.

Be able to communicate appropriately with children and effectively with parents and colleagues.

Be able to describe the pathophysiology, natural history, clinical findings, relevant investigations and management approach for common and important paediatric conditions.

Understand the childhood origins of adult disease

Appreciate the importance of family and societal influences on child and adolescent health

Understand the importance of prevention in improving child and adolescent health

Understand health issues peculiar to adolescence and the importance of transition

Understand patterns of disease , disease prevention and paediatric service provision in an Irish context

3 The Profile of the graduating student

3.1 Clinical Expertise The student is able to:

Demonstrate proficiency in acquiring a complete and accurate paediatric history

with consideration of the child’s age, development, and the family’s cultural,

socioeconomic and educational background.

Describe differences between the medical management of paediatric patients versus

adult patients.

Recognise an acutely ill child.

Demonstrate an approach (the generation of a differential diagnoses, appropriate

initial diagnostic investigations, and management plan) to the core clinical paediatric

presentations (eg fever , cough or abdominal pain)

Demonstrate the required physical examination skills in a skilled and timely fashion

that reflect the comfort, age, development, and cultural context of the infant, child,

or young person

3.2 Professionalism The student is able to:

Demonstrate professional behaviours in practice including: honesty, integrity,

commitment, compassion, respect and altruism.

Demonstrate a commitment to perform to the highest standard of care through the

acceptance and application of performance feedback.

Recognise and respond to ethical issues encountered in clinical practice.

Recognise the principles and limits of patient confidentiality as it pertains to

paediatrics.

Balance personal and professional responsibilities to ensure personal health,

academic achievement, and the highest quality of patient care.

Respect patient confidentiality, privacy and autonomy

Work effectively, respectfully, and appropriately in an inter-professional healthcare

team.

Effectively collaborate/consult/participate with members of the inter- and intra-

professional team to optimise the health of the patient/family.

Understand the importance of priority setting, and time management skills that

balance patient care, academic responsibilities, and personal well-being.

3.3 Communication Skills The student is able to:

Demonstrate communication skills that convey respect, integrity, flexibility,

sensitivity, empathy, and compassion.

Communicate using open-ended inquiry, listening attentively and verifying for

mutual understanding.

Demonstrate a patient-centred and family-centred approach to communication

which requires involving the family and patient in shared decision making, and

involves gathering information about the patients’ and families’ beliefs, concerns,

expectations and illness experience.

Acquire , synthesize and record accurately relevant information from relevant

sources including: family, caregivers, and other health professionals.

Demonstrate organised, complete, informative and accurate information in verbal

patient presentations.

3.4 Advocacy Skills The student understands the role of a doctor in relation to:

Engagement in advocacy, health promotion and disease prevention with patients

and families including: mental health, child maltreatment, healthy active living,

safety, and early literacy support.

Identification of emerging and ongoing issues for paediatric populations who are

potentially vulnerable or marginalized including new immigrants and populations

living in poverty

The importance of community engagement in steering health policy

3.5 Commitment to lifelong learning / quality improvement /

research and education The student is able to:

Engage in self-directed lifelong learning strategies.

Engage in self-assessment through reflective practice.

Apply the principles of critical appraisal of the literature to guide evidenced based

patient care.

Demonstrate integration of new learning into practice.

Understand of the process and importance of quality improvement

Understand the importance of research in advancing medical care, and the

importance of incorporating research into clinical care for patients

4 Essential Core Knowledge

By the end of the undergraduate paediatric training, the student should, at a minimum,

have the following skills:

4.1 Growth Demonstrate ability to accurately plot height, weight, and head circumference

measurements in a growth chart.

Discuss the significance of growth percentiles, with particular attention to an

appreciation of why growth is a good index of health.

Discuss the adverse effects on growth of intrauterine factors, malnutrition,

maternal deprivation, and social/cultural factors.

4.2 Development Describe the developmental changes that occur as the preterm baby matures.

Identify and discuss major developmental milestones and developmental

assessment for birth to 5 years of age.

Demonstrate knowledge of disorders which may lead to developmental delay.

4.3 Health Promotion List the routine schedule of childhood immunizations and which vaccines are

given, their common side effects, and contraindications to their administration.

4.4 Nutrition Describe the importance and benefits of breast feeding.

Describe common nutritional disorders in Ireland including iron deficiency

anaemia and obesity.

State common food formulas for infants, their use, and their limitations.

Describe the causes of failure to thrive.

4.5 Fluids and Electrolytes Recognise and clinically evaluate dehydration.

Calculate maintenance fluid requirements for the paediatric patient with normal

renal function.

Describe the basic physiological principles and their application in the

management of acute dehydration and acute metabolic acidosis.

4.6 Common Paediatric Illnesses A finite list of the paediatric illness or presentations that should be understood by the

undergraduate student is not possible. Included in Appendix 1 is a table of the more

common paediatric presentations that forms the basis of what the undergraduate student

should understand. Each complaint, diagnosis, physical finding/ laboratory test result

(problem) is accompanied by a list of the most common related diagnoses as well as a list of

less common but significant differential diagnoses that may need to be considered. Formal

teaching and student centred learning should cover the common paediatric conditions in a

range of different areas and specialties. These are listed in appendix 2.

More common and relevant conditions should be understood in greater detail than rarer

conditions seen less frequently.

With all of these presentations and conditions, undergraduates are expected to identify in a

range of contexts (primary care, acute care, outpatients):

Key points in the history

Key examination findings

Red flags

Differential diagnosis

Initial investigations

Initial clinical management

5 Essential Skills

5.1 Conduct a Patient/Parent Interview Obtain a history from a Parent/Guardian, as well as directly from the patient if age

appropriate.

Use different styles of questioning - open ended, directed, follow-up, and summary.

Communicate information to parents/patients.

Ensure that both the child and the parent understand the diagnosis and treatment

and have an opportunity to ask questions.

Direct an interview and exam for an acute specific complaint or for a specific

purpose (e.g., evaluation of heart murmur)

Ensure a complete past medical/surgical/neonatal history, family history ,

vaccination history and social history is taken to ensure an accurate overall picture .

5.2 Perform a physical exam Complete a physical examination, incorporating relevant observation/inspection, in

children of all ages

Perform a competent, sensible physical examination of the following systems

o Cardiovascular

o Respiratory

o Abdominal

o Neurological

o Musculoskeletal

o Skin

o Ear Nose and Throat, Head and neck

Adjust the approach, content, sequence, and focus of exam based on the patient's

age.

Assess the child's developmental level, modify the exam accordingly, and use

strategies to improve rapport with the patient.

Demonstrate age specific examination skills for the:

Newborn

o Perform a full neonatal examination.

o Assess infant maturity.

Toddler, pre-school child

o Use techniques for building rapport with children who have stranger

anxiety.

o Assess motor, language, and social development.

Adolescent

o Assess and stage secondary sexual characteristics.

o Be aware of the importance of Tanner pubertal staging

Measurement/Recording

o Measure height, weight, and head circumference.

o Plot and interpret data on growth chart.

o Calculate and interpret BMI.

Specify how individual parts of the physical exam change with the patient's age

and differ from the adult, including:

o Specify how normal values for vital signs change for different ages.

o Elicit primitive reflexes and state when they disappear.

o Identify abnormal hearing.

o Examine the eyes and assess if the infant or child can fix or follow. Look

for strabismus and identify an abnormal light reflex and/or abnormal

visual acuity.

o Examine hips in the newborn using a model and be aware of screening

methods for DDH.

5.3 Written and verbal communication skills Produce a written record of the history and physical examination. The history must:

o Identify the chief or presenting complaint.

o Chronologically organize the present illness.

o Specify the past history with specific emphasis on areas which are unique to

paediatrics, including: Neonatal history (birth weight; approximate gestational

age; complications of pregnancy in mother; exposure to drugs, alcohol,

medications; infections and complications of the newborn period, (such as

prematurity, respiratory distress, jaundice).

o Immunizations.

o Development (6-7 milestones to ask about - social smile, roll over, sit alone,

transfer object, stand alone, walk, say first words).

o Diet (breast fed, formula).

o A detailed family and social history

Detail a review of systems

Document the physical exam, including patient's appearance, vital signs, height,

weight, head circumference, and centiles

Generate a differential diagnosis

List a number of appropriate investigations to enable diagnosis confirmation.

Complete a problem list assessment.

Give an oral presentation that includes the essential elements of the patient's history

in a chronological sequence and a summary of the pertinent physical exam

5.4 Problem solving skills Identify the medical problems during the history and physical exam.

Recognise patterns of illness sharing a unified aetiology

Develop a differential diagnosis for each problem or group of problems which seem

to logically coincide and describe how age affects the differential diagnosis.

Describe the usefulness of laboratory tests which may help to confirm or refute the

clinical diagnosis under consideration.

Discuss the usefulness, limitations, and costs of various studies

5.5 Medicine and Prescribing Explain prescription by weight, age and body surface area in children

Identify common prescribing errors in children

Outline the differences in drug metabolism between infants, children and adults

Identify common aides to safe prescribing in children eg. British National Formulary

for children (BNFc), ward pharmacist

5.6 Practical procedures/investigations Identify the common challenges of undertaking practical procedures in children

Describe techniques for undertaking practical procedures in children eg. distraction,

play therapists, topical anaesthetic

Outline the need to justify practical procedures in children

5.7 Child protection Define the main types of child maltreatment

Describe the symptoms, signs and red flags of child maltreatment

Identify the procedure for raising concerns about child maltreatment

Identify the duty of care for any health professional to report concerns about child

maltreatment

5.8 Legal & ethical basis of child health Be aware of the principles of consent in children and young people including Fraser

competence

Be aware of the principles of confidentiality in relation to children and young people

Identify ethical and legal dilemmas in child health

5.9 Public health and Global health Explain the concept of notifiable diseases

Identify national sources of information about notifiable diseases in children

Outline the social and environmental determinants of child health

List some of the particular health needs of vulnerable groups in child health eg.

refugees, looked after and traveller children

Be aware of the major global health concerns in children

5.10 Patient safety & Quality improvement Understand the importance of patient safety in relation to child health and the

importance of raising your concerns when patient safety is or may be compromised

Outline opportunities to improve patient safety within child health eg. learning from

critical incidents & near misses, quality improvement projects

Demonstrate commitment to continued improvement, reflection and learning

(including from families)

5.11 Essential attitudes/behaviours In clinical practice, demonstrate:

o respect for patients by patient–centred practice

o ethical standards including honesty, integrity, empathy and altruism

o reflection/self-awareness by reflective practice

o personal responsibility for actions by responsible behaviour, including

safeguarding one’s own health and well-being

o teamwork commitment by effective communication and teamwork, including,

where appropriate, acting as the leader of a team

o social responsibility demonstrated by commitment to the health of the

community

Adopt an approach to children, young people and families which:

o is developmentally appropriate

o is non-judgemental and open minded

o shows an understanding of the impact of illness, disease and disability on

children, families and their community as well as on friendships, social

development and education

o recognises the importance of family in a child’s health, growth and development

o shows a willingness to listen to children, young people and their families and

take their concerns seriously

o shows awareness for gender , ethnicity, race and religious belief

Adopt an approach to colleagues which demonstrates:

o respect for, and willingness to work with, the multi-professional team in child

health

o willingness to share skills and ideas with others

Common Complaint Common Diagnoses Other Diagnoses to Consider

Croup Cystic fibrosis

Bronchiolitis Habit cough

Viral respiratory infection Pulmonary aspiration

Bronchitis Foreign body inhalation

Pneumonia

Asthma

Pertussis

Croup (stridor) Foreign body inhalation

Bronchiolitis Interstitial lung disease

Viral-induced wheeze

Asthma

Viral respiratory infection

Pneumonia

Occult bacteraemia Kawasaki's disease

UTI, pyelonephritis Juvenile idiopathic arthritis

Viral infections Tuberculosis

Cervical lymphadenitis Osteomyelitis

Scarlet fever

Meningitis Neoplasms

Septic arthritis

Iron deficiency anaemia Hereditary spherocytosis

Haemolytic anaemia Red cell aplasia

Acute illness Acute ALL/AML

Blood loss Sickle cell anaemia

Beta thalassemia

Non-specific headache Raised intracranial pressure

Head injury Meningitis

Migraine

Sinusitis

Viral illnesses

CF Metabolic problems

Coeliac disease Chronic illness

GORD Anorexia

Breast feeding issues

Non-organic FTT

GOR or GORD Diabetic Ketoacidosis

Gastritis Raised ICP

Acute non-GI infection Drugs

Bowel obstruction Cyclical vomiting

Non-organic

Gastroenteritis Short gut

Toddler diarrhoea CF

Inflammatory bowel disease Malabsorption

Antibiotics

Coeliac disease

Acute urticaria Juvenile idiopathic arthritis

Eczema Systemic inflammatory conditions

Impetigo

Scabies

Viral rashes

Erythema Multiforme

Congenital hip dislocation Osgood-Schlatter disease

Non-accidental trauma Legg-Calvé-Perthes disease

Transient synovitis Slipped femoral epiphysis

Osteomyelitis Leukaemia/tumours

Septic arthritis JIA

Febrile Convulsions Increased ICP

Epilepsy Hydrocephalus

Head trauma

CNS infections

Stills Murmur Valvular Stenosis

Pulmonary branch stenosis (neonates)

Cyanotic congenital heart disorders

Flow murmur (anaemia) Acyanotic congenital heart disorders

ASD/VSD

Familial short stature Skeletal dysplasia

Constitutional delay

Endocrine causes

Chromosomal disorders

6 Appendices

6.1 Appendix 1: Common paediatric and neonatal presentations The following list is not exhaustive and is meant as a guide for the student in relation to

common presentations in children and some of the relevant causes. It should include a clear

understanding of the normal child including health surveillance and the importance of

screening and prevention. It should include a clear understanding of the challenges posed to

families by a child with complex ongoing needs (for example a child with trisomy 21)

Neonatal training should incorporate the following:

The normal newborn

The newborn examination including systematic assessment of the skin , eyes , head

(including palpation of fontanelles and measurement of head circumference) , chest and

abdomen , hip examination , examination for testicular descent , assessment of tone and

examination for primitive reflexes

Common issues in the first 4 weeks of life

The evaluation of jaundice , feeding (including breast feeding) , common rashes , recognition

of trisomy 21 , screening in newborns (including heel prick testing , DDH screening and

screening for congenital heart disease

The sick newborn

Problems seen in preterm infants (IRDS, apnoea, IVH and PDA) , the term infant with

hypoxic ischaemic encephalopathy , suspected sepsis and hypoglycaemia.

6.2 Appendix 2: Key specialties and areas of relevance in paediatrics Formal teaching and student centred learning should cover the common paediatric

conditions in a range of different areas and specialties listed below. A complete and

inclusive list of all conditions and the degree of required knowledge of these conditions is

not possible in this document. More common and relevant conditions should be understood

in greater detail than rarer conditions seen less frequently.

Key Areas of Relevance in Paediatrics

Abuse/neglect Malignant conditions

Allergic disorders Metabolic

Behavioural/emotional Musculoskeletal

Cardiac Neonatal

Endocrine Neurological

ENT Conditions Adolescent Health and Transition

Gastrointestinal Oncology

General Surgical Renal and urological

Haematological Respiratory

Immunity/infection Skin conditions